Political failure has scuppered NHS reform

Telegraph View: The fundamental changes proposed by the Bill now lie in
ruins.

David Cameron told Tory MPs yesterday that changes to the proposed NHS reforms were not about party politics. That is a difficult argument to sustain. Until the Liberal Democrat conference in March, the two parties in the Coalition supported the reforms proposed by Andrew Lansley. More than that, they gave his Health and Social Care Bill a second reading with a majority of more than 80. No Coalition MPs voted against the Government. The Lib Dem conference changed everything. Grass roots activists made it clear to Nick Clegg that they would not accept the wider involvement of the private sector championed by Mr Lansley or what they considered to be his undue emphasis on competition. Ever since, the reforms have been in trouble and the three-month “pause” ordered by Mr Cameron sealed their fate. The NHS Future Forum established to review the proposals has now recommended changes that essentially neutralise the central intent of the Bill, which was to remove Whitehall from decisions that should better be made by clinicians on the front-line.

This was supposed to be in line with the Government’s overall approach to the public services – that local delivery is better than central diktat. Ministers would take a hands-off approach while GP commissioning consortia, a new regulator and a national board would run the NHS. Instead, there is to be a gradual opening up to competition – something that started under Labour – and politicians will continue to have a role through a network of boards and senates. Mr Lansley will today set out where his legislation goes now. The rewritten Bill is expected to make commissioning more accountable, curb moves towards privatisation and overhaul the role of the regulator, Monitor. It is hard to see what is left of Mr Lansley’s original vision or, indeed, why he would want to pilot through Parliament legislation that is so far removed from what he intended.

The least edifying aspect of this mess has been watching the two Coalition partners trying to claim credit for unravelling their own work. No one emerges with their reputation enhanced. Mr Cameron should not have let matters drift in the way they have: NHS reform was always going to be difficult to sell to the public and the reasons for it were never properly set out. Mr Clegg has pulled the plug on a set of proposals he was happy to go along with until his activists told him otherwise. That was a failure of leadership. And Labour’s opposition has been simply opportunistic. Worst of all, this sorry episode has killed off for a generation the reform that the NHS desperately needs if it is to cope with the expensive consequences of demographic change.